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BACKGROUND AND PURPOSE: In preclinical stroke models, high-dose human albumin confers robust neuroprotection. We investigated the safety and tolerability of this therapy in patients with acute ischemic stroke. METHODS: The ALIAS (Albumin in Acute Stroke) Pilot Clinical Trial used a multiple-tier, open-label, dose-escalation design. Subjects with acute ischemic stroke (NIH Stroke Scale [NIHSS] of 6 or above) received a 2-hour infusion of 25% human albumin (ALB) beginning within 16 hours of stroke onset. Six successive ALB dose tiers were assessed ranging from 0.34 to 2.05 g/kg. Neurologic and cardiac function was sequentially monitored. At 3 months, the NIHSS, modified Rankin Scale, and Barthel Index were measured. RESULTS: Eighty-two subjects (mean age, 65 years) received ALB at 7.8+/-3.4 hours after stroke onset (mean+/-standard deviation). Forty-two patients also received standard-of-care intravenous tissue plasminogen activator (tPA). Vital signs were unaltered by ALB treatment. Dose-related increases in plasma albumin and mild hemodilution were maximal at 4 to 12 hours. Age-related plasma brain natriuretic peptide levels increased at 24 hours after ALB but did not predict cardiac adverse events. The sole ALB-related adverse event was mild or moderate pulmonary edema in 13.4% of subjects, which was readily managed with diuretics. In the tPA-treated subgroup, symptomatic intracranial hemorrhage occurred in only one of 42 subjects. CONCLUSIONS: Twenty-five percent human albumin in doses ranging up to 2.05 g/kg was tolerated by patients with acute ischemic stroke without major dose-limiting complications. tPA therapy did not affect the safety profile of ALB. The companion article presents neurologic outcome data and efficacy analysis in these subjects.

Original publication

DOI

10.1161/01.STR.0000231388.72646.05

Type

Journal article

Journal

Stroke

Publication Date

08/2006

Volume

37

Pages

2100 - 2106

Keywords

Aged, Albumins, Brain Ischemia, Cerebral Hemorrhage, Diuretics, Dose-Response Relationship, Drug, Drug Therapy, Combination, Female, Fibrinolytic Agents, Humans, Injections, Intravenous, Male, Middle Aged, Natriuretic Peptide, Brain, Neuroprotective Agents, Pilot Projects, Pulmonary Edema, Serum Albumin, Stroke, Tissue Plasminogen Activator, Treatment Outcome